异基因造血干细胞移植后慢性肾病的新进展

Advances in chronic kidney disease after allogeneic hematopoietic stem cell transplantation

慢性肾病(CKD)是接受异基因造血干细胞移植(allo-HSCT)后的常见并发症之一,主要与急性肾功能不全(AKI)、移植相关血栓性微血管病(TA-TMA)、移植物抗宿主病(GVHD)及BK病毒(BKV)感染等因素密切相关。CKD患者的临床表现包括膜性肾病(MN)、肾小球微小病变(MCD)、TA-TMA相关肾功能不全和BKV性肾病(BKV-N)等。对不同临床表现CKD患者采取的治疗方法不同,其预后亦不同。笔者主要从allo-HSCT后发生CKD患者的高危因素、临床特征、治疗原则、预后等方面进行阐述,以期提高临床医师对该病的认识。

Chronic kidney disease(CKD)is one of the common complications after allogeneic hematopoietic stem cell transplantation(allo-HSCT),which is closely related to acute kidney injury(AKI),transplantation-associated thrombotic microangiopathy(TA-TMA),graft versus host disease(GVHD),BK virus(BKV)infection and other factors.Main clinical manifestations of patients with CKD include membranous nephropathy(MN),minimal change disease(MCD),renal injury related TA-TMA and BKV nephropathy(BKV-N).The treatment and prognosis of CKD patients vary with the clinical manifestations.This article mainly summarizes high-risk factors,clinical characteristics,treatment principles and prognosis of patients with CKD after allo-HSCT,in order to improve the clinicians′understanding of the disease.